90% of hypercalcaemia is due to either malignancy or hyperparathyroid.

Severity: Adjusted Calcium (Ca)

• Severe: >3.5mmol/l – URGENT treatment (risk of dysrhythmia)
• Moderate: 3.0-3.5mmol/l  – PROMPT treatment (maybe well tolerated if chromic)
• Mild: <3.0mmol/l  – doesn’t require urgent treatment and often asymptomatic

Signs/Symptoms

• Brain: Mood change, Reduced GCS
• CVS: Dysrhythmias, Hypertension
• GIT: Anorexia, Vomiting, Constipation, Pancreatitis, Peptic ulcer
• Renal: Thirst, Renal impairment, Renal Stones
• MSK: Muscle weakness

ECG Changes

• QT short
• PR prolonged > AV block
• Wide QRS

Treatment

• 0.9% NaCl – may need 4-6l in 24hrs, requires close monitoring
• Consider Zoledronic acid or Pamidronate – if fluid does not work

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